Stroke：未破裂颅内动脉瘤夹闭后的MR-DWI阳性病灶数有助预测症状性缺血并发症

未破裂颅内动脉瘤夹闭后症状性缺血并发症（症状性缺血并发症SIC、短暂性脑缺血发作或卒中）、微血栓（根据MR的弥散加权图像，即MR-DWI阳性进行判断）的危险因素，以及MR-DWI阳性，即DWI(+)与SIC之间的关系尚不明确。为此，韩国Yonsei医学院Severance医院影像科的Byung Moon Kim博士等人进行了一项研究，研究结果在线发表在2012年11月29日的Stroke杂志上。研究结果发现：SIC组相较无症状组，未破裂颅内动脉瘤夹闭后DWI(+)病灶的数目显着较多。年龄≥65岁的患者存在发生SIC的趋势，当DWI(+)≥切线值(n=6)时，它是预测SIC的唯一独立危险因素。

研究人员在2009年3月至2011年11月间，343位患者的382个未破裂颅内动脉瘤进行了动脉瘤夹闭及治疗后的MR-DWI。回顾性分析SIC和DWI(+)的危险因素及DWI(+)和SIC的关系。

研究结果显示：SIC的发生率为4.1%。DWI(+)的发生率为54.5%。相较无症状组，SIC组的DWI(+)数目显着较大(12.1±10.4 对比 5.0±8.7, P<0.00)。DWI(+)预测SIC的切线值为≥6 (敏感性 85.7%, 特异性70.7%)。DWI(+)≥6的患者占28.6%。在SIC的患者中，DWI(+)≥6的占78.6%。年龄≥65岁的患者存在发生SIC的趋势，当DWI(+)≥切线值(n=6; 95%CI, 1.167–3.083)时，它是唯一的独立危险因素。

该研究显示：SIC组相较无症状组，未破裂颅内动脉瘤夹闭后DWI(+)病灶的数目显着较多。年龄≥65岁的患者存在发生SIC的趋势，当DWI(+)≥切线值(n=6)时，它是预测SIC的唯一独立危险因素。

doi: 10.1161/​STROKEAHA.112.669853
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MR-DWI–Positive Lesions and Symptomatic Ischemic Complications After Coiling of Unruptured Intracranial Aneurysms

Dong-Hun Kang, MD, Byung Moon Kim, MD, Dong Joon Kim, MD, Sang Hyun Suh, MD, Dong Ik Kim, MD, Yong-Sun Kim, MD, Seung Kon Huh, MD, Jaechan Park, MD, Jae Whan Lee, MD and Yong Bae Kim, MD

Background and Purpose—The aims of this study are to evaluate the risk factors for symptomatic ischemic complication (symptomatic ischemic complication [SIC], transient ischemic attack, or stroke) and microembolisms detected as MR diffusion-weighted imaging (MR-DWI)–positive (DWI(+)) lesions, and the relationship between DWI(+) and SIC after coiling of unruptured intracranial aneurysm. Methods—Between March 2009 and November 2011, 382 unruptured intracranial aneurysms in 343 patients underwent both coiling and posttreatment MR-DWI. The incidence of and risk factors for SIC and DWI(+), and the relationship between DWI(+) and SIC were retrospectively analyzed. Results—The incidence of SIC was 4.1%. The incidence of DWI(+) was 54.5%. The number of DWI(+) lesions was significantly larger in the SIC group, than in the asymptomatic one (12.1±10.4 versus 5.0±8.7, P<0.00). The cutoff value of DWI(+) for predicting SIC was ≥6 (sensitivity 85.7%, specificity 70.7%). The patients with DWI(+) ≥6 was 28.6%. Of the patients with SIC, the patients with DWI(+) ≥6 was 78.6%. Patients aged≥65 years had a trend for SIC, and it was the only independent risk factor for DWI(+) ≥cutoff (n=6; 95%CI, 1.167–3.083). Conclusions—The number of DWI(+) lesions was significantly larger in the SIC group than in the asymptomatic one after coiling of unruptured intracranial aneurysm. Patients aged≥65 had a trend for SIC, and it was the only independent risk factor for the number of DWI(+) ≥cutoff value (n=6) for predicting SIC.